Is it safe yet? Patient readiness and perceptions about returning to hospital for planned orthopaedic care

Abstract

Introduction COVID-19 has necessitated significant changes to healthcare delivery but little is known regarding patient opinions of risks compared with benefits. This study investigates patient perceptions concerning attendance for planned orthopaedic surgery during the COVID-19 pandemic. Materials and methods A total of 250 adult patients from the elective orthopaedic waiting list at Cardiff and Vale University Health Board were telephoned during lockdown. They were risk stratified for COVID-19 based on British Orthopaedic Association guidance and a discussion was held to determine patient willingness to proceed with surgery. The primary outcome measure was patients’ willingness to proceed. Results Of the total number telephoned, 196 patients were included in the study, with a mean age of 57.4 years; 129 patients were willing to attend for surgery, leaving over one-third wishing to cancel or defer. The most frequent reason given for not wishing to attend was fear of contracting COVID-19. There was a statistically significant difference in the willingness to proceed observed with increasing clinical risk (χ2(3) = 50.073, p = .000) with almost double the expected count of unwilling to proceed in the high and very high risk groups, equalled by half the expected count in the low risk group. Discussion This study illustrates the variable and personal decisions that patients are making about orthopaedic care because of COVID-19. It highlights the need for change to departmental processes regarding recommencement of planned surgical lists. It also reconfirms the importance of regular communication and shared decision making between a well-informed patient and a holistic orthopaedic team.

The impact of the post‐ COVID 19 pandemic elective waiting list delays on patient reported symptoms and intention to proceed with planned upper limb surgeries—A prospective cohort study

“…In contrast to the findings from the study by Kinghorn et al. (2021), fears of in‐hospital transmission of COVID‐19 were not given as reasons for postponing or cancelling surgery in our study. This could be explained by the post‐pandemic ‘green’ elective surgical care pathways and the lower mortality rates associated with COVID‐19 in the United Kingdom in late 2021 and early 2022.…”

Patient preferences and decision‐making when considering surgery for musculoskeletal disorders: A mixed methods systematic review

“…Seven studies reported an association between general health and decision‐making. Co‐morbidities (heart disease, circulatory disorders, and diabetes) were significantly associated with deciding against spinal (Glassman et al., 2007) and mixed orthopaedic surgery (Kinghorn et al., 2021). Furthermore, in three studies better general health was significantly associated with choosing spinal surgery or knee arthroplasty (Glassman et al., 2007; Gillian A. Hawker et al., 2004; Somerson et al., 2018).…”

“…Complicated by heterogeneous age groupings, six found a significant relationship between younger age and preference for arthroplasty (hip, knee, shoulder or hand) (Chung et al., 2006; G. A. Hawker et al., 2001; Hurley et al., 2020; Kinghorn et al., 2021; Riffin et al., 2018; Somerson et al., 2018), while one found older age was significantly associated with a preference for knee arthroplasty (Zeni et al., 2010). Additionally, six studeis found age to have a non‐significant association with surgical preference (Cronström, Nero, et al., 2019; Kwoh et al., 2015; Modi et al., 2014; Pizones et al., 2017; Trask et al., 2020; Wouters et al., 2019).…”

Decision Conflicts in Clinical Care during COVID-19: A Patient Perspective

“…Therefore, these results are only in part comparable. However, the general picture of highly variable perception of pandemic effects on personal decision making by patients was similarly found in other entities, such as elective surgery, and in various countries, such as the UK [ 37 , 38 ].…”